Pathways of care for HIV infected children in Beira, Mozambique: pre-post intervention study to assess impact of task shifting.

BACKGROUND: In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. A retrospective, pre-post intervention study was designed to evaluate effectiveness of a new pathway of care in a sample of Beira District Local Health Facilities (LHFs), the primary, local, community healthcare services. METHODS: The study was conducted by accessing registries of At Risk Children Clinics (ARCCs) and HIV Health Services. Two time periods, pre- and post-intervention, were compared using a set of endpoints. Variables distribution was explored using descriptive statistics. T-student, Mann Whitney and Chi-square tests were used for comparisons. RESULTS: Overall, 588 HIV infected children (F = 51.4%) were recruited, 330 belonging to the post intervention period. The mean time from referral to ARCC until initiation of ART decreased from 2.3 (± 4.4) to 1.1 (± 5.0) months after the intervention implementation (p-value: 0.000). A significant increase of Isoniazid prophylaxis (O.R.: 2.69; 95%CI: 1.7-4.15) and a decrease of both regular nutritional assessment (O.R. = 0.45; 95%CI: 0.31-0.64) and CD4 count at the beginning of ART (O.R. = 0.46; 95%CI: 0.32-0.65) were documented after the intervention. CONCLUSIONS: Despite several limitations and controversial results on nutrition assessment and CD4 count at the initiation of ART reported after the intervention, it could be assumed that TS alone may play a role in the improvement of the global effectiveness of care for HIV infected children only if integrated into a wider range of public health measures.

Children's Nutritional Rehabilitation Program in Beira, Mozambique: A Retrospective Study.

Malnutrition is still a major public health issue in sub-Saharan Africa and Mozambique. The main aim of this study was to evaluate the adherence to the nutritional rehabilitation program (NRP) and its impact on the growth of malnourished children in Beira, Mozambique. The secondary aim was to verify the prevalence of HIV infection in malnourished children at the time of admission to the NRP. A retrospective observational study in Beira Central Hospital and 10 health centers in Beira, Mozambique, was conducted. All children 0 to 5 years of age with acute malnutrition admitted to the outpatient services of the NRP from March 2016 until February 2017 were included in the study. A total of 1,231 children with the following characteristics have been enrolled: 58% female; 33% severely malnourished; and 16.5% HIV-positive. Of the 198 (21.7%) children who completed the program, 177 (89.4%) recovered from malnutrition and 21 (10.6%) did not. Ten (1.1%) were hospitalized and 706 (77.2%) dropped out of the program. Among children who completed the program, the median weight-for-length and weight-for-height z-scores at admission were ≥ -3 and < -2; at discharge, these median z-scores were ≥ -1 (P < 0.001). Children with HIV infection and who were male had a higher prevalence of severe acute malnutrition (P < 0.001). Weight gain was found to be significant after 23 days (P = 0.004) of consuming supplements (ready-to-use therapeutic food). A diagnosis of the degree of malnutrition was accurate at admission for 70.5%; at discharge, this diagnosis was accurate for 67.2%. The NRP seems to be successful if correctly followed, even if it is limited by adherence problems. However, its effectiveness requires further investigation.

Predictors of therapy failure in newly diagnosed pulmonary tuberculosis cases in Beira, Mozambique.

OBJECTIVE: Tuberculosis (TB) remains a major global health issue, ranking in the top ten causes of death worldwide. A deep understanding of factors influencing poor treatment outcomes may allow the development of additional treatment strategies, focused on the most vulnerable groups. Aims of the study were: (i) to evaluate the treatment outcome among TB subjects followed in an outpatient setting and (ii) to analyze factors associated with treatment failure in newly diagnosed patients with pulmonary TB in Beira, the second largest city of Mozambique. RESULTS: A total of 301 TB adult patients (32.6% females) were enrolled. Among them, 62 (20.6%) experienced a treatment failure over a 6 months follow-up. On multivariate model, being males (O.R. = 1.73; 95% CI 1.28-2.15), absence of education (O.R. = 1.85; 95% CI 1.02-2.95), monthly income under 50 dollars (O.R. = 1.74; 95% CI 1.24-2.21) and being employed (O.R. = 1.57; 95% CI 1.21-1.70), low body mass index values (O.R. = 1.42; 95% CI 1.18-1.72) and HIV status (O.R. = 1.42; 95% CI 1.10-1.78) increased the likelihood of therapy failure over 6 months of follow-up. In this study, patients who need more medical attention were young males, malnourished, with low income and low educational degree and HIV positive. These subjects were more likely to fail therapy.

Children's Nutritional Rehabilitation Program in Beira, Mozambique: A Retrospective Study

Malnutrition is still a major public health issue in sub-Saharan Africa and Mozambique. The main aim of this study was to evaluate the adherence to the nutritional rehabilitation program (NRP) and its impact on the growth of malnourished children in Beira, Mozambique. The secondary aim was to verify the prevalence of HIV infection in malnourished children at the time of admission to the NRP. A retrospective observational study in Beira Central Hospital and 10 health centers in Beira, Mozambique, was conducted. All children 0 to 5 years of age with acute malnutrition admitted to the outpatient services of the NRP from March 2016 until February 2017 were included in the study. A total of 1,231 children with the following characteristics have been enrolled: 58% female; 33% severely malnourished; and 16.5% HIV-positive. Of the 198 (21.7%) children who completed the program, 177 (89.4%) recovered from malnutrition and 21 (10.6%) did not. Ten (1.1%) were hospitalized and 706 (77.2%) dropped out of the program. Among children who completed the program, the median weight-for-length and weight-for-height z-scores at admission were $ 23 and , 22; at discharge, these median z-scores were $ 21 (P , 0.001). Children with HIV infection and who were male had a higher prevalence of severe acute malnutrition (P, 0.001).Weight gain wasfound to be significant after 23 days (P 5 0.004) of consuming supplements(readyto-use therapeutic food). A diagnosis of the degree of malnutrition was accurate at admission for 70.5%; at discharge, this diagnosis was accurate for 67.2%. The NRP seems to be successful if correctly followed, even if it is limited by adherence problems. However, its effectiveness requires further investigation.

Pathways of care for HIV infected children in Beira, Mozambique: pre-post intervention study to assess impact of task shifting

Background: In 2013, Mozambique implemented task-shifting (TS) from clinical officers to maternal and child nurses to improve care for HIV positive children < 5 years old. A retrospective, pre-post intervention study was designed to evaluate effectiveness of a new pathway of care in a sample of Beira District Local Health Facilities (LHFs), the primary, local, community healthcare services. Methods: The study was conducted by accessing registries of At Risk Children Clinics (ARCCs) and HIV Health Services. Two time periods, pre- and post-intervention, were compared using a set of endpoints. Variables distribution was explored using descriptive statistics. T-student, Mann Whitney and Chi-square tests were used for comparisons. Results: Overall, 588 HIV infected children (F = 51.4%) were recruited, 330 belonging to the post intervention period. The mean time from referral to ARCC until initiation of ART decreased from 2.3 (± 4.4) to 1.1 (± 5.0) months after the intervention implementation (p-value: 0.000). A significant increase of Isoniazid prophylaxis (O.R.: 2.69; 95%CI: 1.7­4.15) and a decrease of both regular nutritional assessment (O.R. = 0.45; 95%CI: 0.31­0.64) and CD4 count at the beginning of ART (O.R. = 0.46; 95%CI: 0.32­0.65) were documented after the intervention. Conclusions: Despite several limitations and controversial results on nutrition assessment and CD4 count at the initiation of ART reported after the intervention, it could be assumed that TS alone may play a role in the improvement of the global effectiveness of care for HIV infected children only if integrated into a wider range of public health measures

Taxa de abandono do tratamento antirretroviral (TARV) e seus fatores associados em pacientes adultos inscritos no Centro de Saúde de Namacurra ­ Sede, no período de 1 de janeiro 2015 a 31 de dezembro 2016, na província da Zambézia, em Moçambique / Taxa de abandono do tratamento antirretroviral (TARV) e seus fatores associados em pacientes adultos inscritos no Centro de Saúde de Namacurra ­ Sede, no período de 1 de janeiro 2015 a 31 de dezembro 2016, na província da Zambézia, em Moçambique

O Vírus de Imunodeficiência Humana (VIH) e Síndroma de Imunodeficiência Adquirida (SIDA) continuam sendo um dos graves problemas de saúde pública. A terapia antirretroviral (TARV) veio para a melhoria da qualidade de vida, aumento da sobrevida dos pacientes infetados, mas o desafio da adesão é bastante complexo. Um dos elementos de grande importância para a melhoria da adesão é o não abandono da TARV, assim é de grande importância estudar este problema para contribuir de forma a criação de mecanismos preventivos. Objetivo: estimar a taxa de abandono da TARV e fatores associados, em pacientes inscritos entre 1 de janeiro de 2015 e 31 dezembro de 2016, no Centro de Saúde de Namacurra - Sede, na Zambézia, Moçambique. Específicos: estimar a taxa do abandono da TARV dos pacientes do período em estudo; analisar a associação entre o abandono da TARV e as variáveis sociais, demográficas, comportamentais e clínicas, como o sexo, a idade, estado civil, nível escolar, ocupação, consumo de tabaco, bebidas alcoólicas e outras drogas, alergia medicamentosa, número de CD4, tipo de terapêuticas, seus antecedentes clínicos, estádio clínico da Organização mundial de saúde (OMS), Índice de massa corporal (IMC) e carga viral (CV); Identificar grupos de indivíduos vulneráveis ao abandono de TARV; Identificar indicadores para tomada de decisões preventivas concernentes ao seguimento dos pacientes em TARV. Métodos: Estudo observacional quantitativo, transversal. Os dados foram buscados da fonte secundária, software OpenMRS do projeto da Friend In Global Health (FGH), na Província da Zambézia. Foi feita uma amostra aleatória estratificada por sexo onde 183 eram masculinos e 583 femininos. As associações entre o estado TARV do paciente (abandono ou não) e outras variáveis foram avaliadas a partir do teste Qui-Quadrado ou Exato de Fisher e por regressão logística. Resultados: A taxa de abandono de TARV é de 50.4% Intervalo de confiança (IC) a 95% é de 47% a 54%. Estão associados ao abandono da TARV ser mais jovem (< 35anos) p-valor=0.02, não ter emprego p-valor=0.019, não ter histórico de TARV no passado p-valor=0.02, não ter diarreia crónica p- valor=0.013, não ter tosse prolongada p-valor=0.038, Pressão arterial diastólica alta\hipertensão p-valor=0.038, ter CD4 ≤200 cópias\mm3 . Da associação independente são significativas a idade (p-valor=0.011 e IC95% 0.94 ­ 0.99) com razão de chances (OR)=0.965, e o resultado da última contagem de CD4 (p- valor<0.0001 e IC95% 2.084 ­ 9.837) OR=4.5. Conclusão: A taxa de abandono de TARV encontrada é alta. Para uma melhor qualidade de vida e sobrevida da PVHIV é recomendável taxas mais baixas. É necessário definir-se estratégias para retenção dos mais jovens, indivíduos sem rendas fixas e com baixa imunidade.